Congenital disorders of the Larynx

Supraglottic Glottic Subglottic

Laryngomalacia Vocal cord paralysis Cong. Subglottic

stenosis

Ductal retention cyst Web and atresia Subglottic hemangioma

Cystic hygroma Interarytenoid web Web & atresia

Bifid epiglottis Posterior laryngeal cleft Cysts

Saccular cyst Cri-du-chat syndrome

Anterior laryngeal cleft

Dr AHMED ESAWY

Subglottic stenosis

• Membranous and cartilaginous types.

• Membranous: fibrous soft-tissue thickening of the subglottic area

• Cartilaginous: thickening or deformity of the cricoid cartilage shelf-like plate

• Grading of laryngeal stenosis – Grade I Less than 70%

– Grade II 70%-90%

– Grade III More than 90%;

– Grade IV Complete obstruction

Subglottic stenosis

Dr AHMED ESAWY

Subglottic Stenosis Laryngeal conditions

( laryngocele)

• diltation of ventricular saccule or appendix

• Usually acquired

• Laryngomucocele Saccular cyst if fluid filled

• Laryngocele if air filled

• pyolaryngocele; is an infected laryngocele, filled with pus, is called a it shows a thickened wall on cross-sectional imaging

• Laryngocele is supragglottic abnormality and the true cord is normal

Laryngocele

• classifications: internal, external, and combined.

• The internal (40%) component is medial to the hyoid

bone,inside larynx

• the external (26%)component lateral to the hyoid.

• Mixed (44%) laryngocele on both side of thyriod

memberane.

• etiology

– transglottic pressure, e.g. in trumpet players,excessive cough

– laryngeal carcinoma partial obstruction

– Congenital

– Search for underlying laryngeal cancer

Laryngocele internal,

external, and combined

• acquired

laryngocele

• Mixed laryngocele. Enhanced CT reveals an air-filled

laryngocele straddling the thyrohyoid membrane. The internal

component (arrowhead) is medial to the hyoid bone (asterisk)

and the external component (arrow) is lateral to the hyoid.

Dr AHMED ESAWY

• Trachea radiograph: At the level of the larynx, on the right side,

a peanut-sized saccular protrusion can be seen (arrow).

• EXTERNAL ONLY THAT APPEAR ON X-RAY

Laryngocele Saccular cyst

fluid filled

• Axial contrast-enhanced CT

image through supraglottic

larynx. Bilateral fluid-filled

internal laryngocele(saccular

cyst) (arrows).

Dr AHMED ESAWY

SACCULAR CYST © LARYNGOCELE

AXIAL POST GADOLINIUM

cysts

• Three types

• 1-saccular cyst ( laryngocele)

• 2-mucosal cyst arise within the larynx

• 3-thyroglossal duct cyst arise just outside

the larynx in close assosciation with the

strape muscles

SACCULAR CYST (LARYNGOCELE) (L)

THYROGLOSSAL DUCT CYST

PARAGLOTTIC FAT (ARROWHEAD)

• Axial CT scan of the neck showing the epiglottic

cyst in the pictures above.

INJURIES OF THE LARYNX

• Results:

• Trauma may result in:

• Cartilage fracture.

• Mucosa lacerations.

• Submucosa Hge.

• Membranes rupture and surgical

emphysema

Overview

• Classification of Trauma

– Blunt

– Penetrating

– Inhalation

– Ingestion

– Iatrogenic

VERTICAL FRACTURE OF THE LARYNX

Laryngeal Fracture

• The above axial CT scan shows a fracture of the thyroid

cartilage lamina. Note the presence of an endotracheal tube

Laryngeal F.B.

Complete Obstruction: Death

Incomplete Obst.: cough, dyspnea, Aphonia

Coin In Larynx

ARYTENIOD DISLOCATION

CRICIOD ARROWHEAD

ARYTENIOD ARROW

inflammatory

Epiglottitis

• Epiglottitis is the inflammation of the

supraglottic structures

Radiographic parameters in adult

epiglottitis

• The measurement differences were significant between the groups only for the width of the epiglottis and aryepiglottic folds

•

• Width of the epiglottis greater than 8 mm and of the aryepiglottic folds greater than 7 mm seem highly suggestive of epiglottitis in the adult.

Sites of measurement of

aryepiglottic folds and epiglottis

1-width of aryepiglottic folds at

the mid piont of these folds

2- 1-width of aryepiglottic folds

behind epiglottis

3= 1-width of aryepiglottic folds

at the base of these folds

Epiglottis and

aryepiglottic

folds thickened

in epiglottitis

Classic thumprint appearance of a

swollen epiglottis is pathogonomonic

Of epiglottitis (lateral view /erect)

• CT scan in an adult with acute epiglottitis shows a column of air around the epiglottis (E). The right side is more swollen than the left, and the hypoattenuating area (A) is suggestive of fluid or an early abscess formation.

• A, Axial contrast-enhanced CT scan at the level of the hyoid bone shows marked thickening of the aryepiglottic folds (f), posterior pharyngeal wall, and platysma muscle (arrow). B, Edema is seen in the retropharyngeal space extending to the carotid arteries bilaterally (asterisks) and in the subcutaneous fat. There is obliteration of the paraglottic fat planes and thickening of the false vocal cords (V).

CROUP

• SUBGLOTTIC LARYNGITIS

Croup Vs Epiglottitis

Characteristics of Laryngotracheitis and Epiglottitis

Feature Laryngotracheitis Epiglottitis

Age <3 years >3 years

Onset Gradual (days) Acute (hours)

Cough Barky Normal

Posture Supine Sitting

Drooling No Yes

Radiograph Steeple sign, narrowed subglottis Thumb sign, enlarged

epiglottis,dilated hypopharynx

Cause Viral Bacterial

Treatment Supportive (croup tent) Airway management (intubation or

tracheotomy), antibiotics

CROUP is best appreciated on the AP view

And can be distinguished from congenital

Subglottic stenosis and post-intubation

oedema by history

The characteristic church stipple

appearances of croup results

From subglottic oedema obliterating the

normal subglottic shoulder

Of the proximal airway

CROUP is best appreciated on the AP view

And can be distinguished from congenital

Subglottic stenosis and post-intubation

oedema by history

The characteristic church stipple

appearances of croup results

From subglottic oedema obliterating the

normal subglottic shoulder

Of the proximal airway

Epiglottic Enlargement

• NORMAL VARIANT

– Prominent normal epiglottis

– Omega epiglottis

• INFLAMMATION – Acute / chronic epiglottitis

– Angioneurotic edema

– Stevens-Johnson syndrome

– Caustic ingestion

– Radiation therapy

• MASSES – Epiglottic cyst

– Aryepiglottic cyst

– Foreign body

Aryepiglottic Cyst

• Retention cyst

• Lymphangioma

• Cystic hygroma

• Thyroglossal cyst

• may be symptomatic at birth

• well-defined mass in aryepiglottic

fold

• Diphtheria.. The laryngeal cartilages are collapsed and the laryngeal airway occluded. The thyroid (arrowheads) and cricoid (arrow) cartilages are misshapened. The distance between thyroid and cricoid cartilage is diminished.

Chronic Localized Hypertrophic

Laryngitis:

• Vocal (Singer’s) nodules:

• Etiology:

• Prolonged abuse of voice. Occurs commonly in

untrained voice users as singers and teachers.

• Pathology:

• Localized epithelial hyperplasia and/or sub-

epithelial organized haematoma of the vocal

fold.

• Singer’s nodules.

Dr AHMED ESAWY

Vocal cord polyps (papilommas)

• Etiology: usually complicates an

acute violent voice trauma e.g.

shouting.

• Pathology: Localized sub-epithelial

edema (edematous polyp), vascular

engorgement (vascular polyp) or

fibrosis (fibrotic polyp) of the vocal

fold.

Dr AHMED ESAWY